BMJ  2004;329 (14 August), doi:10.1136/bmj.329.7462.0-f

Filler

POEM^*

Long term budesonide does not affect adrenal function in children

Question Does the use of chronic inhaled corticosteroids affect adrenal function in children?

Synopsis Uncontrolled (for example, cross sectional or retrospective) studies have found that chronic inhaled corticosteroid use in children may affect hypothalamic-pituitary-adrenal axis function. These authors evaluated this effect with a randomised controlled trial (non-blinded) in 63 children with mild to moderate asthma who received standard doses of budesonide (400 µg/day; n = 18) or either nedocromil (Tilade) or placebo (n = 45) for 36 months. At the time of enrolment the children were about 9 years old. Serum cortisol concentrations and response to stimulation with adrenocorticotrophic hormone (ACTH) were measured at baseline and at 12 and 36 months. At both measurements, response to ACTH stimulation was similar in the children receiving budesonide and those receiving nedocromil or placebo. Urinary excretion of cortisol over 24 hours was also not affected overall, although it was significantly lower (P = 0.05) if supplemental inhaled corticosteroid was used in the four months preceding the visit at 36 months. Two caveats: firstly, these 63 children may not be representative of all children with mild to moderate asthma; secondly, the analysis was by intention to treat, instead of by using only the children who had shown continuous use of budesonide. Non-compliance with treatment might also be responsible for the lack of effect.

Bottom line A nagging worry about using inhaled corticosteroids in children has been relieved. In a study over more than 3 years, continuous use of budesonide (Pulmicort) had no effect on serum cortisol concentrations or cortisol response to adrenocorticotrophic hormone.

Level of evidence 1b (see www.infopoems.com/levels/html). Individual randomised controlled trials (with narrow confidence interval)

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Bacharier LB, Raissy HH, Wilson L, et al. Long-term effect of budesonide on hypothalamic-pituitary-adrenal axis function in children with mild to moderate asthma. Pediatrics 2004;113: 1693-9[Abstract/Free Full Text].

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^* Patient-Oriented Evidence that Matters. See editorial ( BMJ 2002;325: 983[Free Full Text])

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